Important notice: Please complete all sections to enable us to select which of our policies best suit you. Our team will then contact you with full details of covers and an indication of premium. Do not worry if there is not enough space, complete what you can and in the comments box at the bottom just ask us to call for more detail. If you wish to phone for a quote you can do so on 0800 289 982.

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About You

 

Title:

Other (please specify):

*Your Name (first and surname):

*Correspondence Full Address:

Correspondence Post Code:

Risk Address:

Risk Post Code:

*Date of Birth:

*Telephone (Daytime):

Telephone (Evening):

Mobile:

Email Address:

Occupation:

 
Buildings

 

Complete Buildings detail even if you only want Contents Cover, just leave Require Cover as "NO".
 
Do you require a Building quote:
 
Are the walls built of Brick or Stone:
 
Is the roof built of Slate or Tile:
 
 
Flat roofed :
 
If YES to the above please state what percentage of your home is flat roofed:
%
 
If NO to either of the over please give details:
 
Property Type
 
Select Property Type:
 
Outbuildings:
 
Shed:
 Garage:
 Stables:
 
If YES are they built of Brick / Stone / Block:
 
Shed:
 Garage:
 Stables:
 
If NO please give details:
 
Year Built:
  
 
Is the property:
 
Is the property your full time residence:
 
If NO please give details:
 
Is the property left unattended for more than 30 days at one time:
 
Is the property used in connection with any business or profession:
 
If YES please give details:
 
Claims in the last 5 years:
 
Claims Value:
  
 
Number of Bedrooms:
 
Alarmed:
 
If an alarm exists is it installed and maintained by a NACOSS approved installer:
 
Security
 
Are your premises secured by British Standard 5 Lever Mortice Locks on all exit doors:
 
Are your premises secured with key operated window lock:
 
 
 
Policy Month Renewal Due:
 
Sum to Insure:
 
Please select the cover you require:
 
Current Insurer (company not broker):
 
Please state Current Renewal Premium:

 

 

Contents

 

Do you require a Contents Quote:
 
General Contents Sum to be Insured (do not include items you wish to insure under Personal Portable Possessions):
  
 
Please select the cover you require:
 
Valuables Sum to be Insured:
  
 
Personal Portable Possessions (whilst in and away from the home):
 
Sum to be Insured:
  
 
If any portable possession exceeds £1,500 in value please give details:
 
Claims in the last 5 years:
 
Claims Value:
  
 
Current Insurer (company not broker):
 
Please state Current Renewal Premium:
 
If you have more than 1 property to insure please call the number on the main page.

 
 

 

Where did you hear about us:

COMMENTS BOX
please enter any other information you wish relating to your requirements.

Data Protection. We may share the information given with the SEIB Group of companies and or other associated companies who can help us enhance our products and services to you. If you do not wish to receive or have your information shared then please change the box to read "NO".